Breast Imaging Guidelines

This policy covers breast imaging services—including screening and diagnostic mammography, breast ultrasound, breast MRI, and evaluations related to reconstruction, nipple discharge, breast pain, suspected male breast cancer, and imaging in pregnant or lactating patients. Advanced imaging generally requires a current clinical evaluation within 60 days (not required for routine screening), prior imaging for comparison is expected, routine standalone ultrasound screening (including for dense breasts) is not indicated, and atypical presentations or requests outside the listed indications require physician review.

"This tool addresses common symptoms and symptom complexes."

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